Determining optimal Free T value

[optimizely]

I am officially confused and do not know what Free T value to aim for and which method to use to calculate it.

It seems the consensus is that Free T direct is useless.

My protocol is 15mg/daily of Test Cyp + .25mg Anastrozole EOD

Trough Bloodwork
Total T 705 ng/dl
Estradiol LC/MS 20.8 pg/ml
SHBG 15.9 nmol/l

Free T Direct 22.9 pg/ml
TruT Calc - Free T 26.23 ng/dl
Issam.ch Calc - Free T 21.8 ng/dl

1. What value should I shoot for
2. What method of calculation is correct?

@Blackhawk
@madman
@CoastWatcher
@Vince Carter
@Vince
@Systemlord

 

[Cataceous]

Use Tru-T; it's the most accurate aside from expensive measurements. The normal range is 16-31 ng/dL, so your level is good.

 

[Vince Carter]

Each method is probably fairly debatable I pay no mind to that part of your question I use the same lab and just take what they give me as I think its more important to have consistency whichever mode you choose or believe it.

Given your low SHBG and E2/AI use...we're very very similar in this regard, just try to shoot for your FT to be at the lab range in the trough and use that as a starting point.

 

[madman]

I am officially confused and do not know what Free T value to aim for and which method to use to calculate it.

It seems the consensus is that Free T direct is useless.

My protocol is 15mg/daily of Test Cyp + .25mg Anastrozole EOD

Trough Bloodwork
Total T 705 ng/dl
Estradiol LC/MS 20.8 pg/ml
SHBG 15.9 nmol/l

Free T Direct 22.9 pg/ml
TruT Calc - Free T 26.23 ng/dl
Issam.ch Calc - Free T 21.8 ng/dl

1. What value should I shoot for
2. What method of calculation is correct?

@Blackhawk
@madman
@CoastWatcher
@Vince Carter
@Vince
@Systemlord

Using the newer TruT Free Testosterone Calculator by FPT.....which has been show to be on par with results obtained by the gold standard Equilibrium Dialysis than your FT (trough) is 26.23 ng/dL (over the mean of the reference range).




TT 705 ng/dL, SHBG 15.9 nmol/L and Albumin 4.3 g/dL (mean) than FT is 26.23 ng/dL (just over the mean 23.5 ng/dL of the reference range 16-31 ng/dL)

1. What value should I shoot for

- most would aim for a moderate----->high/normal FT level at trough

- many men will do well having FT levels in the 25-30 ng/dL range and others may need/feel better running higher levels 30-50 ng/dL range.....as we know every individual is different.....mind you it is highly doubtful one would need to run FT levels well over the reference range.....let alone 50+ ng/dL to benefit from testosterone replacement therapy!

-many can easily do well having FT trough levels at the top of the reference range (high/normal).....especially if thyroid/adrenals are healthy

- keep in mind it is also critical that we are looking at trough FT levels so one needs to understand that protocol (dose/injection frequency) will have a big impact on what FT level to aim for.....if one is injecting larger doses of T less frequently (once weekly) than one would want to make sure FT levels at trough are not too high as peak levels early in the week would be much higher as oppose to one injecting lower doses more frequently as in daily or EOD than one could get away with running a higher FT at trough as peak levels would not be too extreme

- you need to find what FT level you feel best at overall (relief/improvement of low-t symptoms) while keeping blood markers healthy.....let alone preventing/minimizing any potential side-effects










2. What method of calculation is correct?


no-brainer here!






From a previous thread:Gman's Test Prop Labs




Straight to the point:


* highlighted in green- refer to the linear law-of-mass-action model/equation Vermueulen (cFTV)

*highlighted in blue- refer to the new Multi-step Dynamic Binding Model with Complex Allostery (TruT calculated)





[0387] Relation between Percent FT with Total Testosterone and SHBG. Intra-dimer complex allostery suggests that SHBG can regulate FT fraction over a wide range of total testosterone concentrations without getting saturated. Indeed, it was found that percent FT calculated using the new model changed very modestly over a wide range of total testosterone concentrations. In contrast, the Vermeulen's equation suggests a negative relation between percent FT and total testosterone. Furthermore, as SHBG concentrations increase, percent FT calculated using our new model shows only a modest decline in contrast to the marked decline in percent FT calculated using Vermeulen's equation.

 

[Vince Carter]

How did I know we'd get the cut/paste job here.

 

[optimizely]

Use Tru-T; it's the most accurate aside from expensive measurements. The normal range is 16-31 ng/dL, so your level is good.

It just sucks cause there’s such a big difference between the TruT calculation versus the other methods. Which means if you’re basing it off of the other methods and you’re on the very high end of the range, your TruT number would be crazy high

 

[optimizely]

How did I know we'd get the cut/paste job here.

Haha from @madman ?

 

[optimizely]

This is not an exact science. I’m an analytical person, and I’m telling you all this math is just stupid.

You need to run a protocol that many have had success with. Run the lab work to see if anything really strange is going on. Full metabolic panel included to see if lipids, hct, etc are. Or liking the dose.

I wish it was more mathematical so you could easily dial it in. TRT is in its infancy it feels and very ambiguous. No one seems to have a perfect answer. It’s also ironic we’re always told to base our TRT protocol on our Free T levels yet nobody can agree on a method of measuring it

 

[optimizely]

Each method is probably fairly debatable I pay no mind to that part of your question I use the same lab and just take what they give me as I think its more important to have consistency whichever mode you choose or believe it.

Given your low SHBG and E2/AI use...we're very very similar in this regard, just try to shoot for your FT to be at the lab range in the trough and use that as a starting point.

Thanks for the advice bro. I’ll just base my free T off of the labs calculation. I will eventually switch to Exemestane for AI once my arimidex runs out to better control my estrogen. I do better (like you) when my estrogen is in the single digits which I believe requires .25mg ED of Anastrozole.

 

[Vince Carter]

Im on .25mg/D of Anastrozole right now with pretty good E values, not quite where i'd like to be but high teen's and 20's. We think Exemestane was messing with my lipids/chol so I made the switch back to Anastrozole. @optimizely

 

[optimizely]

Im on .25mg/D of Anastrozole right now with pretty good E values, not quite where i'd like to be but high teen's and 20's. We think Exemestane was messing with my lipids/chol so I made the switch back to Anastrozole. @optimizely

That’s awesome! I’m going to go ahead and take .25mg/day of anastrozole to knock down my E. I thought exemestane was supposed to be better for lipids. Guess I had to backwards!

 

[Vince Carter]

I could be the oddball but all my lipids otherwise inexplicably shot way up while using Exemestane.

 

[optimizely]

How are your lipids now? You’re probably right. I’ll look more into it bro.

 

[optimizely]

I could be the oddball but all my lipids otherwise inexplicably shot way up while using Exemestane.

Weird that it negatively affected your lipids. According to two studies on PubMed. Anastrozole negatively affected Breast Cancer women taking the drug whereas Exemestane had a neutral effect on lipids. Guess you’re just an outlier

 

[optimizely]

I could be the oddball but all my lipids otherwise inexplicably shot way up while using Exemestane.

How much did you take of exemestane per day and what was your estrogen level
on that dose?

 

[Vince Carter]

I ran up to 12.5mg per day and I could be in the single digits or low teens with that much.

 

[madman]

It just sucks cause there’s such a big difference between the TruT calculation versus the other methods. Which means if you’re basing it off of the other methods and you’re on the very high end of the range, your TruT number would be crazy high

What is the problem here?

People need to understand the newer research regarding SHBG:T binding and the impact it has on FT levels.

Equilibrium Dialysis is the gold standard when it comes to testing FT.

Unless one is testing FT using Equilibrium Dialysis or Ultrafiltration or using the newer calculated TruT method (which has been shown to be on par with results obtained by Equilibrium Dialysis).....than you truly have no idea where your FT levels sit.

It has been shown over and over that the direct immunoassay (which most rely on) is inaccurate let alone no longer recommended by the Endocrine Society.

Many also use the (cFTV) Vermeulen which has been shown to grossly underestimate FT levels.

If you want to go on and use the other inferior testing methods so be it if it floats your boat @VinceCarter!

LOL.....unfortunately the cut/paste is needed to drive the important points home in those with the thick headed noggins.

Again we can all just sit here and say numbers are just numbers and how you feel overall is what truly matters but the simple fact of the matter is that not only is lab work critical to see how said protocol (dose of T/injection frequency) effects ones TT/FT/e2/DHT levels and overall blood markers but what needs to be stressed is using accurate testing methods to truly know where your levels sit as it can make or break a protocol and save many grief in the long run.

You very well know that many are running FT levels much higher than they think (due to relying on inaccurate testing methods) let alone need.

Of course treating symptoms is what truly matters but one still needs to know where hormone levels sit on such protocol as if we just base it off the "I feel best" nonsense than many men will end up running higher TT/FT (as in well over the reference range) levels than they truly need.

One can easily end up saying I feel best on 200 mg/week.....than it becomes I feel best on 300mg/week and so on.....we are on trt here.....replacement doses of testosterone.....most running these higher doses as in 250+mg/week are claiming trt when in fact their TT/FT levels are well into the supra-physiological range.

If one chooses to run such high levels on trt so be it......but the truth of the matter is most would never need levels this high to benefit from testosterone replacement therapy.

To make matters worse if people on here took the time to understand the newer research regarding SHBG:T binding than they would understand that even if one has higher SHBG very high TT levels as once thought are not needed to achieve a healthy FT level.

Think of how many men are running very high TT thinking that there FT is at a healthy level when in fact it is a lot higher than they think due to relying on piss poor FT testing methods.....all this can be resolved by simply using the newer calculated TruT method which uses a model which is based off the newer understanding of SHBG:T binding.

 

[madman]

How did I know we'd get the cut/paste job here.

Points need to be stressed.....not many take the time to look at things deeply!

You have been on here long enough.....ranting/raving at times.....go on using the piss poor direct immunoassay to make yourself believe your FT levels are such.....it is a shame you would shun the newer calculated TruT method.

I would have expected more from you


Do you feel better now.....getting that off your chest!

 

[Vince Carter]

Points need to be stressed.....not many take the time to look at things deeply!

You have been on here long enough.....ranting/raving at times.....go on using the piss poor direct immunoassay to make yourself believe your FT levels are such.....it is a shame you would shun the newer calculated TruT method.

I would have expected more from you


Do you feel better now.....getting that off your chest!

Weak rant, would not read again. 0/10

@madman

 

[madman]

@ Vince Carter

Remember.....think deeply before you speak.....watch who's toes you step on as you are bound to get picked apart sooner or later and I will be the one to do it!